| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
990 |
615 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,011 |
2,002 |
$43K |
| D1120 |
Prophylaxis - child |
1,527 |
1,514 |
$33K |
| D7240 |
Removal of impacted tooth - completely bony |
225 |
62 |
$33K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
639 |
397 |
$31K |
| D1206 |
Topical application of fluoride varnish |
1,985 |
1,972 |
$26K |
| D1110 |
Prophylaxis - adult |
737 |
737 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,881 |
1,873 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,268 |
2,243 |
$18K |
| D1351 |
Sealant - per tooth |
866 |
294 |
$17K |
| D9243 |
|
200 |
66 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
236 |
233 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
67 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
107 |
81 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,303 |
2,118 |
$6K |
| D0330 |
Panoramic radiographic image |
114 |
112 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
158 |
$3K |
| D9239 |
|
51 |
51 |
$3K |
| D9920 |
|
95 |
78 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
195 |
192 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
76 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
29 |
29 |
$799.82 |
| D9612 |
|
13 |
13 |
$478.92 |